Lifecourse Social Conditions and Racial Disparities in Incidence of First Stroke

TY - JOUR

T1 - Lifecourse Social Conditions and Racial Disparities in Incidence of First Stroke

AU - Glymour, M Maria

AU - Avendaño, Mauricio

AU - Haas, Steven

AU - Berkman, Lisa F

PY - 2008/12

Y1 - 2008/12

N2 - PURPOSE: Some previous studies found excess stroke rates among black subjects persisted after adjustment for socioeconomic status (SES), fueling speculation regarding racially patterned genetic predispositions to stroke. Previous research was hampered by incomplete SES assessments, without measures of childhood conditions or adult wealth. We assess the role of lifecourse SES in explaining stroke risk and stroke disparities.METHODS: Health and Retirement Study participants age 50+ (n = 20,661) were followed on average 9.9 years for self- or proxy-reported first stroke (2175 events). Childhood social conditions (southern state of birth, parental SES, self-reported fair/poor childhood health, and attained height), adult SES (education, income, wealth, and occupational status) and traditional cardiovascular risk factors were used to predict first stroke onset using Cox proportional hazards models.RESULTS: Black subjects had a 48% greater risk of first stroke incidence than whites (95% confidence interval, 1.33-1.65). Childhood conditions predicted stroke risk in both blacks and whites, independently of adult SES. Adjustment for both childhood social conditions and adult SES measures attenuated racial differences to marginal significance (hazard ratio, 1.13; 95% CI, 1.00-1.28).CONCLUSIONS: Childhood social conditions predict stroke risk in black and White American adults. Additional adjustment for adult SES, in particular wealth, nearly eliminated the disparity in stroke risk between black and white subjects.

AB - PURPOSE: Some previous studies found excess stroke rates among black subjects persisted after adjustment for socioeconomic status (SES), fueling speculation regarding racially patterned genetic predispositions to stroke. Previous research was hampered by incomplete SES assessments, without measures of childhood conditions or adult wealth. We assess the role of lifecourse SES in explaining stroke risk and stroke disparities.METHODS: Health and Retirement Study participants age 50+ (n = 20,661) were followed on average 9.9 years for self- or proxy-reported first stroke (2175 events). Childhood social conditions (southern state of birth, parental SES, self-reported fair/poor childhood health, and attained height), adult SES (education, income, wealth, and occupational status) and traditional cardiovascular risk factors were used to predict first stroke onset using Cox proportional hazards models.RESULTS: Black subjects had a 48% greater risk of first stroke incidence than whites (95% confidence interval, 1.33-1.65). Childhood conditions predicted stroke risk in both blacks and whites, independently of adult SES. Adjustment for both childhood social conditions and adult SES measures attenuated racial differences to marginal significance (hazard ratio, 1.13; 95% CI, 1.00-1.28).CONCLUSIONS: Childhood social conditions predict stroke risk in black and White American adults. Additional adjustment for adult SES, in particular wealth, nearly eliminated the disparity in stroke risk between black and white subjects.

KW - African Americans

KW - Aged

KW - Aged, 80 and over

KW - Cardiovascular Diseases

KW - Ethnic Groups

KW - European Continental Ancestry Group

KW - Female

KW - Health Status Disparities

KW - Humans

KW - Incidence

KW - Interviews as Topic

KW - Life Style

KW - Longitudinal Studies

KW - Male

KW - Middle Aged

KW - Models, Statistical

KW - Risk Factors

KW - Social Environment

KW - Socioeconomic Factors

KW - Stroke

KW - United States

U2 - 10.1016/j.annepidem.2008.09.010

DO - 10.1016/j.annepidem.2008.09.010

M3 - Article

C2 - 19041589

SN - 1047-2797

VL - 18

SP - 904

EP - 912

JO - Annals of Epidemiology

JF - Annals of Epidemiology

IS - 12

ER -